The Things That Medical School Won't Teach You (7): A mother is not supposed to die in childbirth

I always knew I'd wind up coming back to the Obs/Gynae Department, a treasure trove of crazy medical experiences. Suffice it to say, my drama in the department began as early as the very first day that I set foot in it. I didn't have the joy of being eased into the department in the manner I would've appreciated. Right after I finished my Surgical rotation, I moved into the Paediatrics Department along with 3 of my other colleagues; my time in Paediatrics was short-lived because an inadvertent gap had arisen in the Obs/Gynae Dept, occasioned by the early departure (read completion) of some of the interns who were in the department at that juncture. So I ended up being cherry-picked to be moved into Obs/Gynae after only 3 weeks in Paediatrics.

So the memory I'm choosing to highlight is Day One of Obs/Gynae, with all the machinations having already taken place.

We began the day with a mortality meeting to discuss the demise of a mother (the dreaded "maternal mortality"). So I sat back listening to one of my fellow interns highlight the patient's history: the patient had progressed to full-blown Eclampsia and had to be placed in the ICU; in addition, the patient's blood pressure had been very difficult to control and the patient's urine bag from her catheter was filled with frank blood where ideally there should have been urine. 

Now in my mind, I'm logically reasoning out that the eclampsia has caused major organ damage and that in addition to ICU care she would also need Dialysis if she was to have any chance of survival; surely there wasn't much that could've been done for this patient. 

This is where the story took a bit of a twist; after the intern had finished her deliberation, the Medical Officers went into attack mode and basically acted like they were pinning the patient's demise on the interns' follies. I even remember that one of the medical officers had rather scathing remarks for the intern who had used intravenous Hydralazine to try to control the patient's blood pressure. 

Interesting side note: (Intravenous) Hydralazine is one of those drugs that medical personnel are very very afraid of using. Quite a potent vasodilator - especially in its intravenous (IV) form - many a medical professional has had the misfortune of having a patient rapidly progress from high blood pressure to low blood pressure/shock or even death after administration of this drug. Some nurses are so afraid of the IV formulation of the drug that they will reconstitute it, and then give it to the doctors to personally administer it. 

Truth be told, the intern was merely following orders of that very same Medical Officer who had recommended the infusion when consulted for help via phone, but it would have been considered sacrilegious to bring it up at that Mortality meeting, especially against a superior. The blame game only ever seemed to have a downward trajectory at those meetings.

In case you aren't aware of it, working in the Obs/Gynae Dept is one of the hardest tasks ever. In most places, particularly public hospitals, the workload is immense; however, it has the added dimension of having the most medico-legal ramifications tied to it. The death of a child is definitely a bad outcome, especially if it ends up being a "fresh still birth", which can pretty much be construed as the medical professional having failed to act in time. On an ever worse scale than that is THE MATERNAL MORTALITY, which, at any time that it happens, generates a storm of controversy that will require explanations to higher-ups in governmental oversight organizations.

I remember one time during a ward round, one of the Obs/Gynae consultants made the following observation:

Childbirth is a natural process. Mothers who come to a hospital to deliver should have a better outcome, otherwise they might as well just deliver at home.

Superficially, this would appear to be an ever-abiding truth, but anyone who has ever worked in an Obs/Gynae ward should know better; after all, "the greatest untruths are truths slightly distorted."  Childbirth is not merely the number of hours that a mother spends in labour and delivery; rather, it is the culmination of roughly 9 months of nutrition, care/neglect, wisdom/folly, health/disease and development that has already occurred prior to actual labour and delivery.

The more distant someone is from the reality that goes into a successful pregnancy and delivery, the more they embrace that aforementioned untruth; in my experience, top brass (especially those in government) are the most likely to be ensnared by this untruth. I remember that when my country (Kenya) initiated a Free Maternal, Child Health Program, they simply declared Maternal Child Health services free at government hospitals, and made sure the public knew as much. So you had mothers rushing in en masse to have their deliveries at hospital, which should have been ideal, right? Actually, because the referral system isn't at its best, mothers overloaded certain hospitals of their choosing (Kenyatta National Hospital - bearer of most suffering - being one of them). Imagine the pandemonium when the medical professionals encountered massive patient loads against no capacity building efforts whatsoever, and handcuffed to the mantra that "a mother is not supposed to die in childbirth".

In my opinion, that mantra needs a little bit of tweaking; a better way of stating it would be that "it is undesirable for a mother to die in childbirth". This reflects the truly complicated dynamic that exists between pregnancy & delivery, and antenatal & post-natal care. When you deal with the common mwananchi, and even people who seem to be of an upper echelon, you get the vivid impression that people "freestyle" this whole pregnancy business. Many were the times that we were discovering a mother's medical problems as we had her up on the table prepping to perform a Caesarean Section (C/S); or better yet, we learnt it as the mother was wheeled screaming into the maternity ward. Here's a taste of that litany:

1. The patient who has managed to go all 9 months without any sort of medical checkup whatsoever. 
2. The mother who has been pushing with each and every one of her contractions, before she was even adequately dilated; her whole vulva and cervix are so oedematous that any chance of normal delivery is gone.
3. The dear soul who chose to augment her contractions (using herbs et al) so that she could speed up the whole process of delivery...which actually only ended up causing foetal distress.
4. The lady with multiple previous C/S scars who chose to stay at home till labour was dangerously upon her, convinced that she could perhaps deliver naturally this time around; unwittingly, she instead puts herself at risk of suffering uterine rupture.
5. Slicing through a placenta during surgery because the mother had an anterior placenta; something that we might've been prepared for if she'd had a recent ultrasound done.
6. The mother who has been suffering from Gestational (aka Pregnancy-induced) Diabetes and hence she's carrying around a massive (macrosomic) baby.
7. The woman who has been blissfully walking around with blood pressure readings that are so off the charts (for example 200/130) that you wouldn't be surprised if she had a stroke right there on the table as you're trying to operate on her.
8. That perfectly healthy young lass so overwhelmed by the whole mystique surrounding childbirth that she insists from the very beginning that she wants a C/S. Worse still if she's gotten reinforcement from friends or unwitting clinicians. Without the proper psyche, good luck getting her to cooperate with the midwives. As an added bonus, this is also the type of patient who the anaesthetist will have an especially hard time administering spinal anaesthesia to. 
9. The mother who has been manhandled or neglected at a peripheral facility, and usually ends up spirited to your facility a bit late in the game. Congratulations, all her problems now become your problems
10. The patient who, despite being an adult of sound mind, is unable to commit to being taken to theater for a C/S without her husband first showing up in person to give consent; this despite the medical professionals being pretty sure that they have a Non-reassuring foetal status (NRFS) on their hands, and that urgent surgery is the best course of action.
11. And with any pregnancy, you face the twin threat of massive bleeding events before or after delivery (aka Antepartum and Postpartum Haemorrhage).
    The causes are many, but by the time they are upon you you'd better act quick or risk losing your patient.

I'm pretty sure that there's more that could be added to the list, but it should at least be an eye-opener. My point in all this is that if you want to have the kind of health outcomes for Maternal Health that are the pride of developed countries, then you have to realize that your outcomes can only be good as the quality of your patients; you also have to be prepared to put in a lot of work.

1. Education of the common people about the importance of Antenatal and even Postnatal care; 
2. Massive investments have to be made into capacity building, because hospitals, and all classes of medical professionals (especially nurses and doctors) won't just appear out of thin air. 
3. Outreach must be emphasized; it''s time to embrace preventive medical aspects wholeheartedly.
   
   I have a personal gripe with how this was done in Kenya because part of it ended up as the "Beyond Zero Campaign" under the First Lady, which in my opinion is misplaced despite the well-meaning sentiment behind it. This decision would be on par with the president deciding to outsource the leadership of the Ministry of Energy's fledgling Nuclear Energy Department to someone without any experience in the field. This is not a pet project, and needs to be recognized as a pillar of healthcare in this country.              
4. Funding needs to be increased, and has to be targeted especially at mothers with High Risk Pregnancies.
   In line with this, ultrasonography has to be considered an essential service for mothers to have access to, and should be covered under Free Maternal Health.

There really are no quick fixes to any of these issues, but I think there is hope for useful course correction if we can all have a clearer appreciation of the bigger picture. I have hope that this would benefit everyone, especially the mothers (actual, potential and otherwise) who are such an important part of our lives. I also hope that I won't be scaring any students away from this Department; even if you won't be specializing in Obs/Gynae, it is still a delightful rite of passage that you shouldn't do without.

God Bless.

Pacific Rim: Uprising - Spoiler Free Review

Pacific Rim 1 this is not!

(It might get a little annoying, but I've got to reference the original movie in some respect.)

From the opening narration, which finds us introduced to the world of Jake Pentecost (Jon Boyega), estranged son of Stacker Pentecost, he assures us that he is not his father (it won't be the last time he reminds us either). Since his father's demise, and the cancellation of the apocalypse, Jake lives a carefree life of debauchery, and is something of a squatter; he funds his life by dabbling in some unsavoury barter trading, which eventually ends up getting him in trouble and forces him to choose the lesser-of-two-evils in order to earn back his freedom. (A nod to his father who was a strong believer in second chances)

The world of Pacific Rim has undergone a massive face-lift since the breach was sealed from the prior installment: humans have had an unprecedented period of peace during which they have been able to rebuild their cities; the Pan Pacific Defense Corps. (PPDC) is also undergoing a remodelling of sorts, with new technology being looked at as a way of leap-frogging the problems of training pilots and the weakness of Neural Bridge Compatibility (which allows 2 pilots to drift, forming the seamless bond that allows them to operate the massive Jaegers).

This movie plays out like a slow burn because a lot of the initial plot is just building up towards the story. It does not have the immediacy that the first movie had because by the time the opening exposition was done, we already had alarm bells ringing, and a quick introduction to the actual devastating power of the Kaiju. Here we witness a new world, get introduced to a new PPDC, and only by the end of the 1st third of the movie are we immersed into the beginning of a convoluted plot mystery which seems a tad more corporate espionage than straight out Kaiju invasion.

It was saddening to hear that Charlie Hunnam's Raleigh Beckett wouldn't be back this time around; however, the movie did manage to bring back Mako (Rinko Kikuchi), and the wacky pairing of Drs. Newt (Charlie Day) and Gottlieb (Burn Gorman). Guillermo del Toro, prior to this sequel, had initially hinted that the drift that Newt and Gottlieb shared with the Kaiju brain as well as possibly having dumped Gypsy Danger into the alternate universe, would be the spark for this movie; the writers honour that in some way, but it seems that most of that played out kinda like misdirection because they take the story down some paths that people haven't necessarily gelled with.

The original Pacific Rim was a beautiful movie which paid homage to Kaiju and Mecha lore; critics threw around references like Godzilla and Gundam, and in my case specifically, I would name "Saber Rider and the Star Sherrifs". This movie felt like it pays homage to yet another book/movie: "Ender's Game." I just haven't the faintest idea why the kids (teens) in this movie were considered so intricate to the plot. Looking back on things, I'm not certain if training the pilots very young was emphasized in the original movie (as much as it was in this one), but there certainly weren't any kid pilots in the original.

Some of the plot points from the original exist in this movie: again they find themselves tracking down the maverick ranger to help with their Jaeger program. In the original, we knew it was because Stacker Pentecost was facing limited funding and was leading an unpopular cause to help end the Kaiju threat. This time around, the situation is a little relaxed, but humanity still holds out some inkling of suspicion that the Kaiju will attempt to make a comeback; thus, rather than defund the Jaeger program, they're pumping in a technological upgrade (much to the chagrin of some of the pilots), but this does not excuse the dearth of adult pilots that we witness within the movie itself.

The only welcome addition to this movie would have to be John Boyega. He is charismatic and carries the movie, delivering the correct amount of sass when it's required. His Jake Pentecost doesn't seem to take most things seriously, probably opting to steer clear of a legacy well curved out by his father, which in all truth is quite eclipsing and engulfing. His character arc, which is the most fleshed out, centres on him coming to terms with this and learning to be his own kind of hero.

His foil for his misdeeds is his partner, Ranger Nate Lambert (Scott Eastwood). Played as a by-the-book "army man", he gives a face to the strict Jaeger program's ethic, which was initially typified by Stacker Pentecost, but doesn't have as strong an archetype in top brass this time around (Ip Man III's Zhang Jin isn't given any real depth in his portrayal of Marshall Quan); He and Jake irritate each other to no end, and compete in more than a couple of ways.
The only other significant character worth mentioning is Jing Tian's Shao; the brilliant head of the Shao Corporation, she's portrayed as ruthless and demanding. The question about where her loyalties lie is what makes her the primary antagonist for the first part of this movie.

The rest of the cast was way too young, and again what makes me feel like they were trying to emulate "Ender's Game". This is that uneasy melding of characters into a plot in previous movies like Transformers, X-men: The Last Stand, etc. where you feel like they can't possibly be of any use to the world if it was required of them. It's the kind of thing that just exceeds a movie's "suspension of disbelief" quota and makes you feel shortchanged; it even detracts from the massive fight spectacles.

Speaking of the action, it is sprinkled in bits throughout the movie; while Guillermo del Toro took his time to emphasize scale of the Jaegers over their maneuverability, Steven S. DeKnight downplays this in some respect to highlight just how very human-like the movement of Jaegers can be. This is particularly true of the fighting style of Saber Athena, which is as sleek as that of a Kung Fu practitioner. DeKnight and the Vfx team still do a good job of establishing the great scale of the action and its set pieces.

All in all, this movie feels like a massive step-down from the previous installment. Some critics argued that the previous movie had a dearth of characterization, but this time around, the movie feels bogged by the convoluted story and non-relatable characters (somehow remembering that one cadet's Dad was a cosmetic surgeon specializing in "breast work" ensures me that nothing useful has been added to the mythos). It saddens me to say that you'd rather wait for this movie to come out on DVD instead of watching it at the cinema/theater. (C+)

God Bless

P.S: Since they seem so set on making this a trilogy (if not a never-ending franchise), at least let them get Guillermo del Toro back in the driver's seat to course correct the next movie.
 

Black Panther "Spoiler-Free" Review

It's actually been more than a week since I watched this movie, but procrastination got the better of me, and I just didn't feel like penning anything too soon. The first day after watching it I felt a little positive about the world, and might've gotten sucked into the feel-good vibes of Wakanda. Anyway, it's had some time to marinate, so I can get into it a little now.

The movie starts off with a nondescript flashback that hearkens back to King T'chaka's time as the titular hero; from there the movie places us right in the thick of things some time shortly after Captain America: Civil War, which was, of course, our first introduction to the Black Panther character in the MCU. So T'challa now has to embrace his role as leader of Wakanda, in addition to his duties as the Black Panther. Aiding him in his administration of his duties are the very nimble and skilled all-female bodyguard force - the Dora Milaje - headed by the fearless Okoye (Danai Gurira). Also fitted in as a spy (and love interest) is Nakai (Lupita Nyong'o). Rounding out the entourage of strong female leads is the Queen Mother, Ramonda (Angela Bassett) and the tech-savvy little sister, Shuri (Letitia Wright).

The female dynamic in this movie was wonderful; the women were strong and intricate to the mythos of Wakanda; unlike a movie like "Wonder woman" where the Amazons stand out as strong warriors in opposition to a male dominated world that is mostly oblivious, the world of Black Panther lets us imagine that the strong woman is embraced, accepted and indeed needed for Wakanda to function properly.

It is essential to explore the concept of "World" as this movie lays it out. The world-building that went into this movie is mind-boggling. Unlike another MCU movie franchise - Thor - which also consists of an otherworldly setting, Wakanda has the feel of a "lived-in"city. No offense to Thor, but, personally, Asgard always felt like a beautiful pearl that wasn't really habitable; it felt like that dinner scene in the first Batman movie when Bruce Wayne sits uncomfortably in the dining room with his dinner date, but can't remember if he's ever had the occasion to sit in that room before. Wakanda seems mysterious as it fades into view away from the illusion of backwardness cast about it, and every one of its settings (with the exception of some poorly rendered "green screen" dreamscapes) come alive. Kudos to the director, the vfx team, and the costume and set designer for scouring African locales for ideas aplenty; the film brims with rich colours and the complexity of Wakandan culture is teased gloriously.

Some people might complain about the pacing of the first act, but in my books it is perfect; enough time to immerse yourself into the many layers of the make-believe world of Wakanda, and to invest yourself in the stakes so that your heart skips a beat once all the moving parts start to complicate matters.   

Wakanda is a technological behemoth that hides itself out of sight to prevent the rest of the world from disturbing its peace. In this way, they are able to keep the benefits and stores of unimaginably powerful Vibranium to themselves, but at the cost of allowing the world to perpetrate atrocities to their black brothers and sisters in the diaspora. This is the underlying thread that dogs T'challa's nascent kingship with his need to be as great a leader as his father, but also to steer clear of traditions that might be less beneficial to the monarchy than initially thought; it is the same thread that also brings Eric Killmonger into the fray with all his irreverence, iconoclasm and vengefully militant stance.  

Does the movie live up to the hype? I would say no. Don't get me wrong, it's a wonderful movie, well-acted and a pretty solid effort.The hype machine went all out for this movie: black director, predominantly (Pan-African) black cast, black writers...blackity black black! There's been no way to escape any of this. 

Is this the first Black "Marvel" hero committed to screen? Certainly not. Honours for that achievement go to Blade which was an eclectic piece of work, and probably the first seriously successful superhero outing predating the MCU and DCEU. Hats off to Blade for also giving us serious vampire baddies in a day and age when "Twilight" has scarred our minds; and lastly, Blade was probably the first R-rated comic book put to screen. 

As you can tell, I am a fan of the Blade Duology, but back to Black Panther. The movie makes good use of most of its characters, practically all of whom are introduced to us for the first time. Every one out here is massively talented and well put to use. Heck, even the extras are immaculate. The only return characters are Martin Freeman's Everett Ross (Civil War), and Andy Serkis' Ulysses Klaue (Age of Ultron). As with all films MCU, there is a dash of humor here and there, but it never gets to be overwhelming. Even the gallant Okoye gets to get in a few jabs at T'challa for his missteps on the battlefield after the casual "I never freeze" boast; and Shuri naughtily discards the decorum of royalty for the trappings of a mad scientist any day.

Michael B. Johnson is given a good villainous role to dig his teeth into. He seems as irreverent in this role as he did in Creed. The movie shows us the things that have marked his upbringing, and at times it manages to get us to sympathize with him; his militancy is off-putting, but even then, one is left to wonder whether a person can surpass all the bad events that colour their initial upbringing. Better yet, one is also left to theorize whether we as a people are capable of rising above the despicable methods that our past tormentors and colonizers have used to subdue us if reality shows that they actually work. Would we be able to carve out new paths, or to merely perfect these dubious acts and use them to fight back "tooth for tooth". Reminded me of "Malcolm vs. Martin" to some extent (and don't blast me for calling people heroes or villains....there are inklings of the differing mindsets at play here).

The only sad thing about the movie is how little they use Ulysses Klaue. We only got a smidgen of him in Age of Ultron, and the same pretty much happens here. He was basically "Von-Struckered" (I don't care if that's not yet a term, I'm claiming it and I'm using it)! Marvel has got to get better about dealing with multiple villains in the same movie; they can't just pile on the villains, and then leave some in a floating mess down the creek...that is unacceptable.

This movie leaves us with many loose threads that could be great fodder for the next Black Panther; it is basically impossible to give any details away without "spoiling" the movie, but rest assured that the Wakanda we started with certainly isn't the same Wakanda at the movie's end; add to this the fact that the events of "Infinity War", whose final battle seems poised to take place in Wakanda, things are bound to get plenty complicated very soon. And I for one am looking forward to everything new this movie will bring to the MCU. These are indeed great time. Wakanda Forever!

God Bless.

   

Walking through Karura Forest

Like all things easily in my grasp, going to Karura Forest is something that I've simply procrastinated about because it was something I assumed I would eventually get down to. For the longest time, I imagined it was somewhere far off (navigation instructions from Google Maps didn't help either); but then in the course of checking on some plants for landscaping, I realized that the entrance to the forest was something I had passed on many an occasion (the Limuru Road entrance); it was, in fact, directly opposite my favourite plant joint.

Anyway, since rediscovering it, I just needed the opportune moment to walk through the forest. Thanks to my new schedule as a casualty worker (2 day shifts, 2 night shifts and 4 days off), I now have ample time to get a lot of things done. Thus, on a Friday not too long ago, I finally decided to check out Karura Forest for myself.

I got to the venue around 10am, and the first thing that struck me as odd was having my backpack searched; mind you, it's not the fact that they were searching me that was strange...it was what they were searching for. Karura has gone on a full scale crackdown on (non-reusable) plastic bottles and bags. Would've made for one hell of a bad day if I'd actually shown up with soda (my vice of choice) and had it confiscated at the gate.

The sweltering heat on that day made me wish that I had started my journey earlier. The pictures don't seem to convey the heat, but it was blistering. At the start of the day, it also seemed quite humid under the canopy; at least more humidity than I've encountered in Nairobi since forever. However, once I got used to things, I was able to enjoy the scenery. There were lots of butterflies along the trail, especially by the waterfall; I was also surprised to run into some duiker along the trail (6 or so), though some of the dung heaps I encountered made me feel like bigger game might have been out and about (or maybe there might have been someone riding a horse on the trail). The beauty of the tall Newtonia trees and Fig trees along the watercourse was really quite fascinating.

Though, I must admit, it would be a better idea to purchase a map before setting out on the trail. I spent a total of 5.5 hours walking around, and probably 1.5 hours of that was from being lost. Some of that comes down to my failure to ask for directions; but then again, when I did ask for directions, I was sent in the opposite direction...as in I was sent to the Kiambu Road Exit instead of the Limuru Road Exit; and lastly, even with a map, those markers can sometimes get downright tricky. I'm referring to a specific Marker 12 which spat me out in the middle of "no man's land", a spot where they were clear-cutting the exotic trees so that they could repopulate it with indigenous trees. For the latter part of my trek, I downloaded a map of the area and was skirting a thin line between checking out the map and trying to save the dwindling battery life of my phone. In my mind, the Marker numbers should have been descending nicely to get me to the main gate; imagine my shock when Marker 12 sent me on a wild goose chase to Marker 33!

By around 3.30pm when I was ready to leave, I was thoroughly tired; but it was a great experience. Was a bit torture-some driving a manual car with leg cramps, but my lesson is learned. Don't feel like I hit everything on the itinerary, but it should be a breeze second time around. Maybe next time I might even take someone else with me. Karura Forest is definitely a great trip whether you're alone, with friends, significant others or even with the young ones. Make a point of visiting when you've got some free time.

God Bless. 

Life Thus Far...

Hello out there! Let me take this opportunity to wish you all a Blessed 2018

I've been looking at my last couple of blog posts and noted that they've been music or movie reviews. Sure, a lot of good stuff did come out last year; I was also choosing to highlight some of the music that inspires me. That notwithstanding, a lot of stuff's been happening (at work) in the background, so I figured I'll key you in on what's happened thus far. In the past couple of months, I've had about 3 department changes occur: in reality it was 3 days in the Casualty Department, a month and a half in the Orthopaedics Department, and now back (for the remaining foreseeable future) to the Casualty Department.

It really has been a welcome change because I had only ever been in the Internal Medicine Department ever since I started out my current stint at the PCEA Kikuyu Hospital (roughly 1 year and 4 months). There were a bit of shenanigans that helmed my first move to the Casualty Dept (which I will not be visiting here), but I figured some amount of change is good; what left me discombobulated was the sudden turn a few days later when I was moved to the Orthopaedics Dept. Don't get me wrong, I live for Surgery; I'd practically accept and bear any position provided that it had a surgical component to it; but the way things were done, it made me feel as expendable as I did when I was an intern. I was so livid at the time, that I did something unexpected (even for me): I basically told the Head of Department that I had no interest in Orthopaedics.

Anyway, soon as the eventualities were done, I started my stint down at Orthopaedics...and strangely enough, I loved the place! I was actually treated like a Medical Officer, and felt like my own man. Granted, the work can be plentiful on some days, especially Tuesdays and Thursdays down at the Outpatient Clinic; but it is true what they say: if you're doing something that you love/enjoy, then it really doesn't feel like work. I missed lunch on many an occasion, and even worked past my hours, but I enjoyed it.

My basic routine consisted of showing up in the morning for the ward round, and then going down to the clinic. The Orthopaedic ward round is really fast: you have the imaging that shows what's wrong with the patient, their blood work, and you just have to figure out which implant or procedure needs to be performed; after that, they just need to work out some logistics between the theater and the stores and off they would go to perform surgery. For some cases, the consultants would slow down their pace and teach a thing or two. The team on the round consisted of Consultants, a Registrar, a Medical Officer (myself), two interns (Medical and Clinical Officer), a Physiotherapist, and a Theater Nurse.

The ward round was pretty routine and we'd zip through patients really quickly. The only occasions that would demand something extra from my time would be the cases where some sort of medical complication was involved. Seeing as I had spent all that time in the Internal Medicine Dept, I at least provided a chance for patients to get a quick medical review for comorbidities like Diabetes, Hypertension, Pneumonia, etc at the Orthopaedic unit; the alternative would be for them to transferred to the General Unit where they would have their cases reviewed by the physician.

After the ward round, it would be down to the clinic to deal with a large number of patients. Numbers sometimes felt overwhelming, but I was part of a great team. Anyone who needed an orthotic device either got sent to the Limb Shop or the Physiotherapy Dept; if it was something I couldn't handle, my Consults were around for speedy consults; Plaster Technicians also lent a hand in helping me decide which fractures could be dealt with conservatively, or which ones needed urgent surgical management; and lastly, the nurses helped with booking patients into slots for surgery as per our surgical calendar. (Some of them would even chase me off so I could take a tea break or a lunch break :)

I figure I'm only 2 months or so into my Casualty stint, but it seems like Orthopaedics was such a long time ago. Casualty is its own unique animal, with a few fringe benefits, but I miss the regularity of Ortho. At Casualty, I'm on Day Duty for 2 days (each 10 hours), then on Night Duty for 2 days (each 14 hours), and then I get 4 days off. Usually, I spend the 1st day off in a daze and lazing because sometimes that last night shift just punches me in the gut; but the next 3 days are magic, and I have so much free time on my hands to get things done, and perhaps finally delve into some useful hobbies.

Thus far, it's going well. Hoping things only get better.

God Bless

The Music of Kendrick Lamar - Keisha's Song

It's hard to believe, now, that there was ever a time when Kendrick Lamar (aka K-Dot) wasn't on the musical map. He's world famous, grammy nominated (and won), and by all accounts is still delving deeper into his craft.

I can attest that my first introduction to Kendrick was a really short one. A college friend of mine had A.D.H.D posted up on his Facebook account. I didn't know much about K-Dot, but all that straight cursing in the chorus (which also doubles up as the intro) just turned me off. So I just turned it off. Anyway, my truest introduction to him was on "Power Circle" by the MayBach Music Group (MMG). I'm definitely not a Rick Ross fan (and his contribution is the worst of the song), and it didn't help that he does the intro to the song. Anyway, one day I randomly let the song play out and was surprised by two contributors: first up, Wale, switched up his flow and had poetic bars; surprise two was the ultimate reveal - Kendrick Lamar.

Power Circle is really a chest-thumping track with each contributor chiming in either a lyrical boast, or some rags-to-riches story; but Kendrick's verse is different, eclectic, otherworldly, and its content is all over the place...it totally shocks you (in a good way). Literally, his intro, which is a one-breath 12-second take, was,

"Look inside the eyes of the last Mohican survived | You won't last the weekend outside | Seen a pastor tweaking that sank his teeth in a rock his demise | Later on in the evening you had the grieving of angels that cried | See a demon don't compromise"

This wasn't mere bravado; this was Kendrick elevating the song to something else. Some people seeing this as being a bit "extra", but I believe a lot more people appreciated the extra effort.

After wearing out that verse, I immediately set out to find out more about K-Dot. This was before "Good Kid M.A.A.D City" (GKMC) dropped, so I got to listen to "Overly Dedicated" and "Section.80", and some of his collabos on Youtube. Through Section.80, I encountered A.D.H.D again (and viewed it a little more favourably this time), but the concept album also served up another gem: "Keisha's Song (Her Pain)."

This song has been referred to as this generation's version of Tupac's "Brenda's Got A Baby"; Kendrick get's more self-referential when he raps that

She (Keisha) play Mr. Shakur | That's her favourite rapper | bumping Brenda's got a Baby while a pervert yelling at her 

Sure, this is conscious rap, and so we've got many ways to tell similar stories. Tupac's tale of a minor from a dysfunctional family whose life spirals downward after getting pregnant is a sad story; however, what pulls me out of the moment is that excessive R&B crooning they have on the track, and I don't favour the instrumental background either. One truth still remains about how I listen to music: I've got to resonate to the beat before I can even relate to the words. Not easy to catch the message if the beat is putting me off.

So, for Keisha's song, we get a flipped version of the Alan Parson's Project track "Old and Wise", which I had encountered once on Zion I's ode to Hip Hop "Bird's Eye View". The sample here is only slightly recognizable in the intro and then they warp it; they took that opening Violin/Oboe section and manipulate it, then they sprinkled in the opening piano notes to give this epic soulful feel. After that, they just added in a hard beat, and added a little more piano to fill it out. There used to be a video floating around of how it was done, but maybe it got taken down when Kendrick got sued for using the sample. Anyway, part I is cool for me: the beat is perfect!

Part II is the storytelling. Kendrick weaves a story of Keisha, an under-aged prostitute, basically showing us what a day in her life is like. The first verse focuses on her getting herself ready so she can hustle to make the money, which she doesn't see much of; the second verse tackles her paranoia about her profession, which is necessary by default because of run-ins with the police, one of which is detailed here; the third verse brings things full circle and we're given the impression that Keisha has been numbed into this way of life. She wasn't taught anything better. Unlike Brenda, it's her father who is missing from the family picture, and it's her mother's boyfriend who ends up taking away her innocence so early in life; because she wasn't taught anything better, she lacks the tools to turn her guilt into redemption.

I won't really delve into all things Kendrick does to make this song so poetic. Would take too much time, and it would sap the joy out of this little post. I will focus on one point that he specifically uses to contextualize/ground these verses; he basically makes a point of starting each verse,

"Lord knows she's beautiful | Lord knows the usuals leaving her body sore..."

Similarly, the end of each verse begins in (more or less) the same way:

It was a block away from Lueder's Park, I seen the El Camino parked | And In her heart she hate it there, but in her mind she made it where nothing really matters | Still she hit the back seat..."

He uses this very ending to emphasize a concept from each of the verses; in as much as it's something familiar, each verse is propelled in a different direction. In the first verse it focuses on her profession, with the back seat as her "office", the second focuses on her "satiating"a police officer, and the third shows us that more than being a mere office, the back seat is the "bondage" into which abuse pushed her; ultimately, it leads to her demise.

Ashtrobot (aka Ash Riser) provides a short Sinatra-esque chorus that bookends each verse, reminding us that Keisha's not alone on these streets.

"Fancy girls on Long Beach Boulevard, flagging down all of these flashy cars" 

I love this song and consider it Kendrick's best to-date. There is some vulgarity in the song (actually less than I've always thought it had considering the subject matter), but it doesn't detract much from the matter at hand. This is what Rap music can be at its best, giving us a lens into some of society's more gritty aspects, and giving us much food for thought. And there is a lot to unpack here; in case you might have missed it, this song is referenced and addressed in "Sing About Me" from GKMC, and takes on an eerie aspect once you realize that his sister, who he says he played this song to as a warning, also ended up getting pregnant as a minor.

This song for me is ultimate Kendrick. It may get lost in his discography now that he's famous, but if you get a chance give it a listen and marvel at his best work ever.

Have a great day.

Star Wars: The Last Jedi Review

The way things have been going lately, I've been feeling like the fates have been conspiring to keep me from watching this movie: on one day it was a website wrongly listing their showing as 2D (when it was in fact 3D), which messed things up; on 2 other occasions, there was just mad traffic on Ngong Road - and surprisingly slow drivers - that kept frustrating me. Well anyway, finally got to watch it today, so now I can add my 2 cents to the mix.

This is one grand chase of a movie; I don't think Princess Leia Organa has been pursued this much by the Supreme Leader since Episode IV (A New Hope). It helps that she has Poe Dameron on her side to bring the fight to the First Order; fleeting victories aside, the First Order is making most gains this time around, and bringing the rebels to their knees (pretty much the way they did in The Empire Strikes Back). Since his previous loss, Kylo Ren isn't having the best of times and Supreme Leader Snoke is ever so eager to play his own mind games, kicking his apprentice while he's down. This is pretty much Snoke's mentorship style, and you get the feeling that Kylo Ren's not the only one facing this cruel and unusual punishment.

This episode then picks up where the last one ended: with Rey encountering Jedi Master Luke Skywalker. That last shot might have hinted that Luke was ready to get into the fray, and to take up a new apprentice that could undo what his very last one had seemingly irreparably damaged (a la Obi Wan). Turns out Luke is tired of all the things he's seen, and probably just waiting out his time on that distant island so that he can pass into memory, taking the Jedi ways with him.

The movie is a really tight knit story blending these two overarching arcs, and we have one separate side mission sprinkled in which is a sort of "Hail Mary"move to save the resistance.

I was deeply engrossed in this movie from start to finish and I fail to see why it was polarizing at all. I'd dare say that this is a better movie overall than The Force Awakens. There's a myriad of characters here, and I feel like this time everyone has something to do. This movie is beautifully shot: Luke's island getaway is a scenic craggy outcrop that you feel might be a little more sinister than it looks; and there is nothing more beautiful than the salty barren wasteland of Crait, with its white salt surface, which is gently raked to reveal the fiery red salts below.

With the exception of Capt. Phasma, every character feels really well fleshed out. Kylo Ren benefits the most from an added storyline. I don't know if it was Adam Driver's or J.J. Abrams' decision to make him seem like a spoilt child, but seeing him trash a console in The Force Awakens made him seem more like a tantrum-prone child than an adult seeking to emulate his grandfather (Lord Vader); we have less tantrums at play here, but more of measured outbursts. He is still conflicted, but even when he's being evil, you never get the feeling that he's the consummate baddie.

The relationship between Luke and Rey mirrors his own short lived time training under Master Yoda. Luke is jaded, but also very guilt-ridden, hoping to play out life in a familiar routine until he meets his demise. It is the lost-yet-seeking Rey who prods him, forcing him to re-examine his values and come to terms with the role he can still play in the resistance. It helps that his doubt helps bring forth a mythical character whose screen presence lights up and serves one of the best dramatic moments onscreen. For her part, Rey is still seemingly innocent and lost in her thoughts; but her hold on good is concrete, and stands in stark contrast to Luke's loss of faith, and ends up being his saving grace.

There's also a beautiful dynamic between Princess Leia and Poe Dameron; this time around, we see more of Poe and his heroics; however, his heroics are more in the line of "be-triumphant-or-die-trying," or as he would put it, "Jump in an X-Wing and blow something up." To paraphrase one lesson that Leia gave him, "that's how dead people end up being heroes, but not leaders." Leia, reflecting the wisdom of age, and the reluctance to willingly sacrifice her troops (a trait notable in those battle-hardened warriors who've experienced many a loss in war), is a steady anchor in this fight, and pulls some surprises on us...one of which includes her up until now minimal use of the force. Poe ultimately helps orchestrate the splinter arc that sees Finn and Rose sneak off undercover to another beautiful setting that seemed like Tuscany under moonlight (Canto Bight).

Rose is a new addition, but her stake in this fight is clearly elucidated from early on in this movie. The trip to Canto Bight is a further glance into her history. Having Finn along for the ride is something that organically develops, with him being initially thwarted from following an earlier plan, but ends up being used in a scheme that may or may not save the Rebels. His motivation is clear: all he does is meant to safeguard Rey and to give her a chance at survival.

A Star Wars movie wouldn't be complete without a roster of  special animal friends and machines. Chewie, R2D2, BB-8 and C-3PO deliver their usual cinematic flair, with all of them providing some levity in this drama heavy affair. The Millenium Falcon is also in full force here, providing yet more grief for a new generation of First Order fighters. Rey and Chewie as co-pilots provide that wonderful Han Solo/Chewie dynamic that's a throwback to the previous trilogy, and the hunk of junk still flies like a beauty.

I really loved this movie, and consider it a worthy addition to the franchise. After the turns made in this movie, as well as an inescapable real life event as Carrie Fisher's death, the final part of this trilogy promises to be something wholly new. However, if it's left in the hands of Rian Johnson, it'll still turn out great.

I give this movie a solid A, and would recommend that you check it out in all its cinematic glory on the big screen.

God Bless

BRIGHT Spoiler-Free Movie Review

I was definitely riding the hype train for this movie from the time it started gaining traction. It seemed like the fusion of two diverse genres would make for an interesting take; in their words, "Lord of the Rings" meets "Training Day". From the beginning you get the whole Training Day feel - gritty portions of LA, with members of the LAPD trying to hold fort against all the lawlessness; then the stratification of the different races - Elves, Humans and Orcs - is of course a nod to The Lord of the Rings. They have of course flipped the typical white vs minority dynamic with the Orcs being the lowest rung of the ladder this time around; however, they haven't changed things completely: you still find the black and latino gangsters sprinkled in aplenty.

This movie is like a "Flashpoint Paradox" moment: something happened 2000 years ago, which is what brought all the current events into play; this set of events shifted the course of history, giving us the current world as it stands now. However, you get the feeling that this is not a complete departure from what the world would previously have been...with the exception of the few additional races.

Our view into this eclectic world comes through the life of Officer Ward (Will Smith), a down on his luck, grumpy individual who has the bad luck of being partnered with the department's latest diversity offering: Orc officer Jakoby. As can be expected, tensions are high all around. Jakoby really has the worst of it all because he's ostracized by all races alike: the Orcs think he's a traitor and humans and elves alike can't stomach his presence, and question his loyalty. Ward has to weather everything thrown his way (even though none of it is of his own doing), and find some way to cope, whilst also showing the rookie Jakoby the ropes, and hoping that Jakoby will be vigilant enough to cover his back.

This maelstrom of events only gets worse when a magic wand is thrown into the mix.

This movie has polarized quite a few people: the critics seem to despise it to no end, but audiences are more positive about it. I liked the concept of "Bright", this wonderful eclectic fusion; but this movie reminds me of "John Wick" in one regard: the most interesting character in the movie remains hidden, as if it's an afterthought. In the case of John Wick, it was "The Continental", the mysterious domicile with all its traditions and trimmings; in this movie's case, it's the lore which stands out as the mysterious hidden character. Characters give minor exposition of a war fought in times past with different sides chosen by the warring parties; there's mention of the Dark Lord; and by the time the wand pops up, you're given the impression that everyone knows about magic, specifically what a powerful instrument like a wand can do, but you have no idea whatsoever how they know it.

What ails this movie most is balance. It has great ambitions, but in the end it provides us more of a gritty drama than it does a Sci-Fi fantasy.

Despite coming short on fulfilling all its promises, the movie is still a great watch. Will Smith is always a pleasure to watch, even when he's being a presumptuous and disrespectfully uncouth lad; his performance has the perfect foil in the form of Joel Edgerton. Now, I gotta say, when most actors undergo extensive makeup and prosthetics for a role, in most cases you can still recognize them; even when they're CG'd up via Motion capture (like the Hulk), you can still see nuances of the actor in the CG creation. Joel Edgerton's Jakoby is totally unrecognizable; even his mannerisms are different. It definitely helps sell the fish-out-of-water dynamic.

Noomi Rapace is menacing as Leilah, one of the inferni (rogue elves). Her menace comes more from her physicality than from her words. Her polar opposite is Tikka, a timid young elf whose past is also tied to Leilah's. We only get one small flashback that alludes to this past, but not much else to inform us of the inferni's motivations. After watching this movie, you'd be excused for thinking that all inferni are lethal assassins because once Leilah and her two henchmen show up, they settle scores with anyone in their paths immediately.

Edgar Ramirez's Kandomere is an elf federal agent whom the trailers would've had us believe plays a big role in the plot; I feel like most of his role is elucidated through exposition (mostly his own), and he plays up quite a big game...unfortunately, maybe his truly juicy scenes might have been sacrificed on the cutting room floor.

Perhaps Bright was always planned to be a trilogy from the start. It feels like there's a larger story to tell, and we've only scraped the surface. I'm honestly waiting for the 2nd part of the chapter, but hoping that it's diametrically different from this movie; hoping that the lore of this world gets a full fleshing out and a satisfying end.

All in all, I'd give Bright a B+, but would be open to bumping it up higher if I could watch it juxtaposed against a lore-heavy part II.

Till then, God Bless

Justice League "Spoiler-Lite" Review

Was a really hectic day at work this past Friday, that I barely realized I was in the clinic past my clock-out time (and that was without any breaks at all). On my way home, about 5.20 pm, I just decided to check on the timings for Justice League, which my brother had assured me would start playing at the theaters as of Wednesday. Lo and behold, there was a 2D showing at 6.30pm at the Junction Cinemax. The way I figured it, even with the nasty Friday traffic on Ngong Road (Both ways!), I could still make the trip in about an hour, and, even with all eventualities, be able to watch the movie. I cut it pretty close, but I made it right on time.

So, pretty much taking its cue from Batman V Superman (BvS), this story plunges us into the DCEU's version of "The Death of Superman" storyline. The introductory sequence is very reminiscent of the title sequence from "Watchmen", serving as a sort of dirge that shows how the world has been shaped by the events of Superman's death; it has pretty much sapped most of humanity's hope, basically starting off some major doom and gloom as if a sort of doomsday clock has gone off; and, suddenly, something begins to feed off of that gloom: enter Steppenwolf and the parademons. Batman and Wonder woman are tasked with ushering in a new age of heroes by bringing together the other (until now) incognito and disparate superheroes to form a team.

I won't lie: I've been guarded about the hype surrounding this movie ever since the DCEU jumped off on Man of Steel and followed that up with Batman V Superman. Invariably, this discussion will involve a Marvel Cinematic Universe (MCU) comparison, but with good reason. The animated division of DC has been very good at producing wonderful animated movies, some of which have already captured (very well) some of the classic stories that are just now being translated to the DCEU. You need look no further than "Superman: Doomsday", "Batman: The Dark Knight Returns", "Batman: Assault on Arkham", Wonder Woman (2009) and "Justice League: War" for direct comparisons to Batman V Superman, Suicide Squad, Wonder Woman and even Justice League. Some might argue that in this regard, the animated movies have done a better job of telling the stories.

A lot is happening in this movie: there's the back story to the mother boxes, a war pitting many earthly forces against an unwelcome invader (who isn't entirely repulsed), and then we're also getting more fleshed out introductions to 3 of our heroes who only had the smallest of cameos in BvS.

1. Aquaman, as shown from the trailers, has built up a following of sorts, and has indulged in heroics; he has the trident in his possession, and he interacts with Atlantis to some extent (at least they won't be going the "Justice League: Throne of Atlantis" way). 
2. The Flash is in his pre-police force phase and is living off the grid. By all accounts, he has the suit, but he's still a nascent superhero whose greatest feats have consisted of pushing people out of the way, and gunning it. Suicide Squad had that segment where he encountered Capt. Boomerang; don't know if that's a DCEU continuity issue, or if the old Capt. isn't considered one of his greater rogue gallery entries - only time will tell.
3. Cyborg is as fresh as they come. BvS gave us the impression that he'd already been formed prior to the Doomsday fight, but here he seems like a relatively recent creation. (I don't exactly know if it's a continuity error, but this time with his creation, there's a bit more of his human components than we glimpsed in his prior BvS creation). Wouldn't exactly qualify as an exact Justice League: War iteration, but he's pretty close. The artificial intelligence from the mother box continues to reshape him, and at times, neither he nor his teammates are fully convinced of which side he's truly on. Seemed like they mixed in his character with quirks from Blue Beetle.

First off, let's start with the positives: Ben Affleck's Batman is still a joy to watch. He's a tad less jaded than he was in BvS and a bit more philanthropic. Though, this time around he's dealing with disposable parademons, so we don't know whether he's totally rid himself of the ruthless killer instinct he displayed in his previous incarnation towards humans. And now this is where I insert a SPOILER-LITE portion in this review: they have finally done Superman justice. You'd have to have been living under a rock or skipped all press related to this movie to think that Superman wouldn't be a part of the League. Anyway, for the first time in 3 movies, they've finally latched onto the things that humanize Superman; heck, he even gets away with making a joke or two. Gone is that depressed sullen character from MoS and BvS, and here we finally have a hero worth his title. But don't let that fool you, once he brings the godhood, he is bad-ass. His first interaction with the Justice League establishes that there really is none of them that is a match for him (which pretty much blows the BvS characterization out of the water). Overpowered he may be, but that is what Superman has always been.

Despite all the one-liners and seemingly one-dimensional character of Aquaman, I actually enjoyed his presence on the team. He has a gruff exterior and he pretty much tells it like it is. You feel like he profits the least from having a seat at the table with the League (a role which was usually reserved for Batman in the animated Justice League), but he sticks it out and comes through for the team.

I'm also happy about the course correction that the DCEU seems to be making. Trying to make all their movies with a paintbrush of seriousness that should ideally only be reserved for Batman has truly complicated things. For one thing, it has totally ruined Superman thus far. I mean, the space refugee, last of his kind shtick was really too much. He's humanoid looking enough and mostly benevolent that they should never have had to turn him into a depressed golem. This was probably because of the depressing influence of Jonathan and Martha Kent in the DCEU more than anything else.
I don't know if this was a Joss Whedon decision or if it came from Zack Snyder himself, but it was welcome to have the heroes joke around and smile. After one unfortunate thumping, hearing Batman complain about "something definitely being broken" was hilarious. The extreme end of this humour is brought on by Barry Allen (The Flash); because he's such a newbie, he comes off like a nervous wreck, and they use his discomfort to inject humour into a lot of his situations. Unfortunately, sometimes it lands, and other times it doesn't. Maybe once his rookie-ness wears off, we might get a more balanced representation. Lastly, thank God that Lex Luthor Jr. was only restricted to a post-credits scene; his wrongness for the role has never been in doubt, and for the love of life, I hope they never find an excuse to shoehorn him into any further league movies. Maybe they could find a way to resurrect his dad and kill Jr. off permanently

On the negative side, this movie feels like it would definitely have profited from being slightly longer. Between the past exploration of the war, and the introduction of some of the heroes, things feel a bit rushed. Going the "Age of Ultron" route of letting special characters develop organically within a movie that is already chock full of other pre-established characters and storylines is a recipe for disaster. I want to relate to them, get invested in them, but I feel like if the writers had decided to kill off these under-characterized heroes (a la Quicksilver), I'd shrug it off as nothing meaningful. I would definitely have cut out most of Lois Lane and Martha Kent's scenes in this movie, because, with few exceptions, none of them were pivotal to the story.

The movie also does get a bit CGI heavy in some instances. Don't get me wrong: the speed force is a beautifully rendered alternate reality of wonder, and a highlight of the film. Granted, the big baddie and his minions are CGI creations, and so is Cyborg, some real world environments could've helped out. I heard one critic praise the Themyscira war scene, but the CGI was a bit too jarring for my tastes. Steppenwolf and the parademons were rendered well, but Cyborg is 50/50. There's just something very uncanny valley about the way he looks while walking out of a plane, and when his head is viewed from the side in quick cuts. It's probably something they'll have to firm up before they decide to put him on screen again. As for Superman's upper lip and the CG-deleted 'stache...well, I actually didn't notice it in the movie, so that's that.


There's also one very glaring issue. (Spoiler Lite again!) The movie only seems to highlight the plight of one family in this far flung area where bizness is going down. Then by the time things are climaxing, the situation has changed (turns out there might have been more people in that area than we were led to believe). I mean, seriously, even Justice League: War did it better. All those parademon numbers needed to be repopulated, and sadly, that means a lot of humans ended up being carried off and converted. They could've actually shown us some of this stuff to up the stakes. Dunno if they felt the ratings would have been switched up if they showed us something that graphic, but it would've made the movie more satisfying.

In this case, I feel certain that a Director's cut would actually improve the movie (that's not always the case: watched the BvS one - was still a disaster). Now that they've finally gotten the League out of the gate, they need to slow down and develop their iconic characters. They've got the time and a worthy stable of characters and storylines to keep us entertained for years to come. I definitely wouldn't recommend them choosing an iconic storyline like "The Flashpoint Paradox" this early in the game, but then again, it's their money to throw away (again and again).

I'm 50/50 on this movie, a bit confused about whether it did what it set out to do. I'll give it a B and maybe give it a second watch on another occasion.

God Bless.

Thor: Ragnarok "Spoiler-Free" Review

So, Thor: Ragnarok basically showed up in theaters this Wednesday, and I've basically been waiting for a long time to watch this movie. This is the Marvel Cinematic Universe's (MCU) second last single outing before we get into the massive team-up event of "Infinity War". Up to this point, the MCU now has 3 complete trilogies, which have yielded varying degrees of success. The hallmark has been the Captain America trilogy which went from strength to strength, first with a World War II period piece, then evolved into a beautiful spy thriller for its second outing, and came full circle with the mash-up that was "Civil War". Next up is the Iron Man trilogy; Iron Man is considered the starting point of the MCU, but his movies have had a strange trajectory with each entry being weaker than the last. With the completion of the Thor trilogy, we can take a look at the course these movies have taken.

Thor's characterization has been difficult to pin down. Asgard and all the realms associated with Thor's universe are what bridges the rest of the MCU with each other. How else could disparate properties like "Guardians of the Galaxy" and pretty much everything terrestrial in the MCU be brought together if not through Thor? The first movie was like a Shakespearean play: big hero who's heir to the throne does something unbecoming and ends up being stripped of his powers and summarily banished to earth; after learning some humility and showing some regard for human life, he gains back his powers and his place as the rightful heir. The second movie took a much darker path, digging further into the lore of Asgard and introducing an infinity stone in the form of the Aether; having Jane Foster play the unwitting host to the Aether was a move to introduce her to the Asgardians (one which probably wasn't appreciated too highly by the fans).  

As I've mentioned before, Thor has been hard to place in this MCU. They've gone with the "Ultimate" version of Thor's universe, therefore, rather than being magical god-like creatures, Asgardians are really just a technologically advanced race; but then again, Thor typifies a Tony Robbins' quote that I ran across a while back,

"It is not necessary to understand everything to be able to use everything"

Technologically advanced the Asgardians may be, but you get the feeling that Thor doesn't really understand how it all works (not the sharpest tool in the shed). At some point in this movie, Thor chides Hulk for being the dumbest avenger, but that might be a toss up between the two of them. In the past 2 movies, Thor barely fits in with the Midgardians (human folk), with the exception of the Avengers. He is a god among men, and out of place even when juxtaposed against the posse (Jane, Darcy and Erik) that is meant to humanize him.

So this movie takes a totally different route. It puts a spanner in the works, putting a stop to the increasingly serious tone between the first two movies; instead, this one serves up the laughs aplenty. Also, the human element is almost lacking from this movie; if Thor is a god, let's get to see what he's like among other gods (lesser or otherwise). Especially when it comes to the laughs, you'll pick the tonal shift very early. He's talking to a heavy-hitter, and the humour was a tad overpowering. This was the only part where it took me out of the moment, much in the same way I couldn't take Tony Stark's PTSD arc in Iron Man III serious.

Fortunately, the action kicked into top gear and the movie pulls you back in. Shortly after, we get to see how things are falling apart since Loki's being hiding under the guise of Odin. It's priceless to see Loki's death scene from Thor: The Dark World played to comedic effect with the most surprising of cameos (I seriously doubted my eyes the whole time I was watching the scene play out). It's a quick trip from there in search of Odin, which brings us to earth and a wonderful encounter between Dr. Strange and the Asgardians. It's hard to tell how much time passes in the MCU and where the movies fit into the timeline, but from the dexterity with which the good doctor handles the magical arts, you can tell that he's finally settled into his role as the sorcerer supreme. Handling the Asgardian presence on earth (particularly Loki's) as something of a nuisance, he reunites them with Odin to ensure the safety of earth.

The reunion is short-lived, but enough for Odin to let us know that something bad is coming; his foreboding is not limited to the event itself, but he lets us in on a dark secret that lets us know that he is in a way responsible for what's coming. The trailers and clips have given us a bit of exposition concerning the encounter between Thor, Loki and Hela, and how exactly they end up on Sakaar, and how they end up meeting the rest of The Revengers team members - Hulk and Valkyrie - but maybe not in the way you're expecting. In an era when poorly constructed trailers threaten to expose entire movie plots willy nilly, there's a surprising amount of randomness in which the story comes together. A traditional buddy cop movie (like happened in Iron Man III), this is not. However, dysfunctional or otherwise, this is the team that needs to get back to Asgard to deal with the big baddie.

I think this movie achieved what it's going for. It's a beautiful movie with vibrant colours and expansive worlds. More than that, it also expands the lore in a welcome direction. Multiple story arcs have been assembled to come up with this version of the story. There's a touch of the Ragnarok, Planet Hulk, and Gorr the Godbutcher storylines; probably more things in there too, but they are tastefully amalgamated. Thor, despite all the comedy, finally comes into his own. Despite feeling hapless for losing Mjolnir, he comes to embrace his role as the god of thunder, and all innate abilities and responsibilities therein. And if there's anything he learns quite well, it's that "Asgard is not a place, but its people".

Loki has also morphed into an entirely new character. When we first met him, he was finding himself in his role as the god of mischief; in The Avengers, he was pretty much an astringent villain; but here he still makes mistakes, but he's beginning to embrace himself as somewhat of an anti-hero.

Bruce Banner/Hulk does not feel like an afterthought either, and that's probably because The Planet Hulk storyline so organically implants his presence in this movie. It is a travesty that we haven't gotten a new Hulk movie to expand the character for this new universe (I refuse to count 2008's Incredible Hulk as having brought anything useful to the MCU). The Banner/Hulk relationship is more tenuous this time around, with Banner totally buried within their fractured psyche since he fled on the Quinjet at the end of Age of Ultron. As per the comic, Banner's presence made no sense on Sakaar because the world was too hostile to accommodate his puny physique; however, since they're shifting thing around for this adaptation, some exposition would be great for exploring this fractured psyche.

Cate Blanchett is a wonderful addition to the cast as the villainous Hela. She has a ravenous appetite for violence, but in her own way she reflects an individual who is looking for recognition in the only way she knows how. Her path partially mirrors that of Loki, someone on the outside looking in, hoping for acceptance and validation. Her exposition gives us a peek into a darker less benevolent Asgardian past, and I feel like she would be a welcome villain in future MCU installments. (Might even prove to be a worthy foe for the likes of Dr. Strange).

Tessa Thompson as wonderfully cast as Valkyrie, a seemingly incorrigible drunk with a traumatic past who is initially the bane of Thor's existence on Sakaar; but her bad habits aside, she steals every scene she's in, and her path towards redemption is worth the watch.

Even Jeff Goldblum is a welcome addition. Even his typical "mannerisms" only add more zest to the ridiculous entity that is the Grandmaster. He is wonderfully egotistical, and he infuriates Thor to no end with his frequent mispronunciation of "Asgard" or Thor's title.

The humour also melded well, despite the serious tone that "Ragnarok" is meant to imply. After a really rough bump at the start, I feel like it was the right tonal choice for this movie. This movie must be preparing us for the kind of loss that we're going to experience during the Infinity War because some people meet rather untimely ends in this movie. It just happens with a finality that'll shock you, and you barely even get a chance for it to sink in. I'm hoping that there's a chance for rebirth, like that shown in the comic, such that we will get a chance to meet some of these fallen heroes again. (One can only wish...)

It's been hard to put words to this review without giving spoilers, so perhaps I might just have to delve into spoiler territory with another review to further contextualize what I was unable to say. Suffice it to say, this was a great movie (A+), and a wonderfully good time. I might just be up for watching this again come next weekend; who knows, might even treat a friend to it (time will tell).

God Bless.